WELBROOK SENIOR LIVING SANTA MONICA

Official classification

Type B

Official code

87411(c)(1-6)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements 87411 (c) (1-6) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 . This requirement is not met as evidenced by: Deficient Practice Statement Based on observation,interviews,and record review, the licensee did not comply with the section cited above in 4 out of 4 staff members did not have proof of trainings in their file for S1,S2,S3,and S4, nor could the administration staff provide proof of trainings for any staff members which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/26/2025 Plan of Correction The Adminstrator Catalina Cole has agreed to provide training to all support staff members and provided proof of training signed and dated by staff members along with a statement of understanding of the cited regulation by the POC date of 9/26/2025 by email to Bernadette.allen@dss.ca.gov

Official classification

Type B

Official code

87468.1

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following… (2) To be accorded safe, healthful and comfortable accommodations... This requirement was not met as evidenced by: Based on interviews and records review. Licensee did not ensure the safety of (R1) who wandered out of the facility, unsupervised by staff. R1 Sustained a serious injury during elopement from facility on 2/2/24.. This violation poses a potential health and safety risk to clients in care.

Official plan of correction

The administrator to complete and submit a written plan to LPA ensuring the safety of all residents via email to Deborah.Lee@dss.ca.gov by POC due date 4/10/25.

Deadline recorded: Apr 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(e)(7)

Regulation authority

CCR

What the official deficiency says

87705 (e)(7) Care of Persons with Dementia (e) Licensees that use delayed egress devices on exterior doors... shall meet the following requirements…(7) Delayed egress devices shall not substitute for trained staff...to meet the care and supervision needs of all residents, including staff needed to escort residents who need supervision to leave the facility. This requirement was not met as evidenced by: Based on interviews, and record review staff were not on 2nd floor where R1 eloped from at time of incident and did not hear the alarm.This violation poses a potential health and safety risk to clients in care.

Official plan of correction

Administrator agreed to ensure that there will always be staff on 2nd floor including during shift transition periods. The administrator to forward policy to LPA via email by POC due date 4/10/25.

Deadline recorded: Apr 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. LPA identified staff #6 not have criminal record clearance transfer. Staff did not have an LIC 9162 on file nor transfered on CDSS Guardian. This violation which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/22/2024 Plan of Correction Licensee will ensure all staff have criminal clerance transfer prior to working at the facilty. Staff #6 according to CDSS Guardian is not associated to this facility. Licensee will associate staff #6 by POC due date. Send proof of correction by email to ernand.dabuet@dss.ca.gov

Official classification

Type B

Official code

87705(5)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia - (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. LPA identified resident #2 & #4 both diagnosed with dementia did not have current medical assessment & reappraisal. Last assessments were done in 2022. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/12/2024 Plan of Correction Licensee will ensure that all residents diagnosed with dementia will have medical and reappraisal done annually. Proof of correction for resident #2 & #4 of current medical assessment & reappraisal be completed and submitted by email before due date to ernand.dabuet@dss.ca.gov

Official classification

Type B

Official code

80075(f)

Regulation authority

CCR

What the official deficiency says

(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above. Staff #3 #4 #5 did not have First Aid/CPR certificate on file. This violation which poses a potential health, safety, or personal rights risk to persons in care

Official plan of correction

POC Due Date: 10/12/2024 Plan of Correction Licensee/Administrator will ensure all facility staff must have the mandatory First Aid/CPR Training completed. As plan of correction, administrator will send proof of completed First Aid/CPR will be sent to LPA via email: ernand.dabuet@dss.ca.gov before POC due date.

Official classification

Type B

Official code

80066(a)(10)(11)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information: (10) A health screening as specified in Section 80065(g). (11) Tuberculosis test documents as specified in Section 80065(g). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above. Staff #3 did not have a health screening nor TB test results on file. This violation which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/12/2024 Plan of Correction Licensee/Administrator will ensure all facility staff have completed a Health Screening LIC 503 and TB test results. As plan of correction, administrator will send proof of Health Screening LIC503 with TB test results to LPA via email: ernand.dabuet@dss.ca.gov before POC due date.